Maternal care, pregnancy complications and birth outcomes among native and migrant women in Portugal

Migrants can experience inequalities in care and health outcomes even in countries with universal access to care, regardless of legal status, as it is the case in Portugal. Thus, we assessed the prevalence of late antenatal care, pregnancy complications, obstetric interventions and birth outcomes considering the country of origin of women delivering in Portugal Methods: As part of an ongoing population-based study, enrolling native and foreign-born women recruited in 32 Portuguese public hospitals at delivery, 3884 women were classified in groups according to their country of origin and native country language as Portuguese (PT), Portuguese speaking Latin American Countries (BR), Portuguese speaking African countries (PALOP) and other countries (PNSC) Results: The prevalence (%) varies for late antenatal care (p<0.001), from 14.5 (PT) to 29.8 (PALOP); pre-eclampsia/eclampsia (p = 0.031), from 0.8 (BR) to 2.4 (PALOP); instrumental vaginal birth (p<0.001), from 8.6 (PALOP) to 18.1 (PNSC); C-section before labour (p<0.001), from 11.5 (PNSC) to 15.2 (BR); and C-section during labour (p<0.001), from 15.5 (PNSC) to 21.7 (PALOP). No differences were found for twin pregnancy (p = 0.128), gestational diabetes (p = 0.283), placental disorders (p = 0.743), induced labour (p = 0.138), preterm delivery (p = 0.897) or admission to Neonatal Intensive Care Unit (p = 0.918). Conclusions: Health inequalities in care of migrant pregnant women are particularly evident for those born in African countries with Portuguese as the official language. Key messages: In Portugal women coming from different countries converge in regards to indicators of perinatal health. Speaking the language of the host country does not overcome inequalities of care among migrants.info:eu-repo/semantics/publishedVersio

Tobacco use during pregnancy among native and migrant women in Portugal. Results from the bambino study

Tobacco use is a major modifiable risk factor of adverse maternal and fetal health outcomes. Being a migrant has been associated with lower risk of smoking during pregnancy. However, it remains a matter of debate whether such association could be explained by other socio-demographic characteristics or whether such effect remains or increases according to the length of stay in the host country. This study examined the differences in maternal smoking prevalence between native, long-term and recent migrant women in Portugal. METHODS: This study was derived from baMBINO, a national project grounded on 32 public maternity units in mainland Portugal aiming to investigate the differences in perinatal healthcare and outcomes among migrant and native women. Recruitment took place during admission for delivery, inviting both native and foreign-born women. Participants included in this analysis (n=1107) were classified according to their country of birth and length of stay in Portugal into: native (Portuguese-born), recent migrant (foreign-born women who spent 10 years or less in Portugal), and long-term migrants (foreign-born women who spent more than 10 years in Portugal). Logistic regression model was fitted to estimate the association between the aforementioned migration statuses and having or not smoked tobacco during pregnancy, taking into account women’s age, parity, marital status, level of education, family income, country of origin of women’s parents and gestational age at the first prenatal care visit. Adjusted odds-ratio (OR) and respective 95% confidence interval (95%CI) were obtained. RESULTS: A little over half of the study participants were foreign-born and almost 60% of those were recent migrants. Tobacco smoking during pregnancy was evidently more prevalent among native women than among long-term or recent migrant women (14% vs. 8% and 4% respectively; p<0.001). Compared to native women, both long-term and recent migrant women were more likely to be unmarried, have a family income lower than 1000€, and have their first prenatal visit after 12 weeks of gestation. Long-term migrants were more likely to have Portuguese-born parents than recent migrants (26.0% vs. 2.5%; p<0.001). According to the multivariate regression model, having a higher educational level was significantly associated with not smoking during pregnancy (secondary school: OR=0.38; 95%CI:0.23–0.62; postgraduate education: OR=0.18; 95%CI:0.09–0.35), opposed to women who have 9 or less years of education. However no association was observed between smoking during pregnancy and maternal age (OR=1.10; 95%CI:0.60–2.01 and OR=0.95; 95%CI:0.57–1.58 for women aged less than 25 and 35 or more years, respectively, in comparison with women aged 25-34 years), family income (OR=1.30; 95%CI:0.77–2.18 for women with higher income), parity (OR=0.68; 95%CI:0.43–1.09 for multiparous in comparison with primiparous women), gestational age at first prenatal visit (OR=1.12, 95%CI:0.59–2.11 for women having their first prenatal visit after 12 weeks), having a foreign-born parent (yes vs no: OR=0.83; 95%CI:0.43–1.63) and marital status (single vs married women: OR=0.76; 95%CI:0.46–1.24). Smoking during pregnancy was significantly less frequent in recent and long-term migrants (OR=0.24; 95%CI:0.10-0.57, OR=0.52, 95%CI: 0.25-1.09 respectively) compared with native Portuguese women. CONCLUSION: Results of this study demonstrated significant disparities in the prevalence of maternal smoking during pregnancy according to the women’s place of birth and duration of stay in Portugal. Native-born women had a higher risk of smoking during pregnancy than foreign-born women. The increase in the duration of stay in the host country seemed to have a negative effect on maternal smoking of migrants in Portugal. Smoking cessation health strategies in pregnant women in Portugal need to be improved by taking into account the mentioned variations in smoking behaviors.info:eu-repo/semantics/publishedVersio

Tobacco use during pregnancy among native and migrant women in Portugal: results from bambino study

Tobacco use is a major modifiable risk factor of adverse maternal and fetal health outcomes. Being a migrant has been associated with lower risk of smoking during pregnancy. However, it remains a matter of debate whether such association could be explained by other socio-demographic characteristics or whether such effect remains or increases according to the length of stay in the host country. This study examined the differences in maternal smoking prevalence between native, long-term and recent migrant women in Portugal. METHODS: This study was derived from baMBINO, a national project grounded on 32 public maternity units in mainland Portugal aiming to investigate the differences in perinatal healthcare and outcomes among migrant and native women. Recruitment took place during admission for delivery, inviting both native and foreign-born women. Participants included in this analysis (n=1107) were classified according to their country of birth and length of stay in Portugal into: native (Portuguese-born), recent migrant (foreign-born women who spent 10 years or less in Portugal), and long-term migrants (foreign-born women who spent more than 10 years in Portugal). Logistic regression model was fitted to estimate the association between the aforementioned migration statuses and having or not smoked tobacco during pregnancy, taking into account women’s age, parity, marital status, level of education, family income, country of origin of women’s parents and gestational age at the first prenatal care visit. Adjusted odds-ratio (OR) and respective 95% confidence interval (95%CI) were obtained. RESULTS: A little over half of the study participants were foreign-born and almost 60% of those were recent migrants. Tobacco smoking during pregnancy was evidently more prevalent among native women than among long-term or recent migrant women (14% vs. 8% and 4% respectively; p<0.001). Compared to native women, both long-term and recent migrant women were more likely to be unmarried, have a family income lower than 1000€, and have their first prenatal visit after 12 weeks of gestation. Long-term migrants were more likely to have Portuguese-born parents than recent migrants (26.0% vs. 2.5%; p<0.001). According to the multivariate regression model, having a higher educational level was significantly associated with not smoking during pregnancy (secondary school: OR=0.38; 95%CI:0.23–0.62; postgraduate education: OR=0.18; 95%CI:0.09–0.35), opposed to women who have 9 or less years of education. However no association was observed between smoking during pregnancy and maternal age (OR=1.10; 95%CI:0.60–2.01 and OR=0.95; 95%CI:0.57–1.58 for women aged less than 25 and 35 or more years, respectively, in comparison with women aged 25-34 years), family income (OR=1.30; 95%CI:0.77–2.18 for women with higher income), parity (OR=0.68; 95%CI:0.43–1.09 for multiparous in comparison with primiparous women), gestational age at first prenatal visit (OR=1.12, 95%CI:0.59–2.11 for women having their first prenatal visit after 12 weeks), having a foreign-born parent (yes vs no: OR=0.83; 95%CI:0.43–1.63) and marital status (single vs married women: OR=0.76; 95%CI:0.46–1.24). Smoking during pregnancy was significantly less frequent in recent and long-term migrants (OR=0.24; 95%CI:0.10-0.57, OR=0.52, 95%CI: 0.25-1.09 respectively) compared with native Portuguese women. CONCLUSION: Results of this study demonstrated significant disparities in the prevalence of maternal smoking during pregnancy according to the women’s place of birth and duration of stay in Portugal. Native-born women had a higher risk of smoking during pregnancy than foreign-born women. The increase in the duration of stay in the host country seemed to have a negative effect on maternal smoking of migrants in Portugal. Smoking cessation health strategies in pregnant women in Portugal need to be improved by taking into account the mentioned variations in smoking behaviors.info:eu-repo/semantics/publishedVersio